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Hasiba-Pappas S, Kamolz LP, Luze H, Nischwitz SP, Lumenta DB, Winter R. Regenerative Therapies for Basal Thumb Arthritis-A Systematic Review. Int J Mol Sci 2023; 24:14909. [PMID: 37834357 PMCID: PMC10573355 DOI: 10.3390/ijms241914909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Basal thumb arthritis is a painful and debilitating pathology that can severely reduce a patients' quality of life. Common therapies include oral pain control, local steroid injections and/or surgery. Yet, therapeutic data on long-term improvement and even cartilage repair are scarce. This review aims to present the currently available literature on novel therapies for basal thumb arthritis, including platelet-rich plasma (PRP), fat grafting and phototherapy, and investigate their potential efficacy. The entire OVID database and PubMed were searched for studies containing the topics PRP injection, lipofilling, laser treatment and regenerative treatment for carpometacarpal arthritis. Seven studies on the effect of fat tissue on basal thumb arthritis were found. Four authors reported on PRP injections, one RCT examined a combinational treatment of PRP and fat grafting, another phototherapy for the thumb joint and one prospective trial on chondrocyte transplantation was found. Pain improvement and decreased impairment were reported in the majority of PRP and/or fat grafting studies as well as after chondrocyte implantation. Phototherapy did not significantly improve the condition. This review revealed that only limited data on regenerative therapies for carpometacarpal arthritis are currently available, yet PRP and lipofilling show promising results and merit further investigation.
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Affiliation(s)
- Sophie Hasiba-Pappas
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Lars-P. Kamolz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research GmbH, Neue Stiftingtalstr. 2, A-8010 Graz, Austria
| | - Hanna Luze
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Sebastian P. Nischwitz
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - David B. Lumenta
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
| | - Raimund Winter
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 5, A-8036 Graz, Austria; (S.H.-P.); (L.-P.K.); (D.B.L.)
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Herold C, Lange J, Rennekampff HO, Allert S, Meyer Marcotty M. Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: Long Term Results. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:511-515. [PMID: 35272382 DOI: 10.1055/a-1737-4541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Initial results after autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis have been promising. But long-term results have not yet been available. METHODS In a prospective study, 42 patients with thumb carpometacarpal joint osteoarthritis were observed for a mean time of 5 years after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to numerous analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire score (DASH score) before and after treatment were analysed. RESULTS The average pain preoperatively was 8.0 ± 1.6 and 4.0 ± 3.0 after 5 years overall. Force and pinch force of the treated hand improved from 71% and 60% preoperative in comparison to the non-treated hand to 100% and 96%, respectively, 5 years after fat transplantation. There were similar improvements for the parameters strength and DASH score. All improvements were statistically significant. No serious adverse events were observed. CONCLUSIONS Autologous fat transplantation is a real alternative to trapeziectomy even in the long term in basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in basal joint osteoarthritis of the thumb as it offers stable results and warrants a high patient satisfaction rate.
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Affiliation(s)
- Christian Herold
- Plastische und Ästhetische Chirurgie, Medizin im Mühlenviertel, Bremen, Deutschland
- Chirurgische Klinik, Sektion für Plastische und Ästhetische Chirurgie, DIAKO Bremen, Bremen, Deutschland
| | - Janina Lange
- Chirurgische Klinik, Diako Bremen, Bremen, Deutschland
| | - Hans Oliver Rennekampff
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Rhein-Maas Klinikum GmbH, Würselen, Deutschland
| | - Sixtus Allert
- Plastische Chirurgie, Sana Klinikum Hameln-Pyrmont, Hameln, Deutschland
| | - Max Meyer Marcotty
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie / Handchirurgie, Klinikum Lüdenscheid, Lüdenscheid, Deutschland
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Major G, Longoni A, Simcock J, Magon NJ, Harte J, Bathish B, Kemp R, Woodfield T, Lim KS. Clinical Applicability of Visible Light-Mediated Cross-linking for Structural Soft Tissue Reconstruction. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2300538. [PMID: 37424046 PMCID: PMC10502829 DOI: 10.1002/advs.202300538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/28/2023] [Indexed: 07/11/2023]
Abstract
Visible light-mediated cross-linking has utility for enhancing the structural capacity and shape fidelity of laboratory-based polymers. With increased light penetration and cross-linking speed, there is opportunity to extend future applications into clinical spheres. This study evaluated the utility of a ruthenium/sodium persulfate photocross-linking system for increasing structural control in heterogeneous living tissues as an example, focusing on unmodified patient-derived lipoaspirate for soft tissue reconstruction. Freshly-isolated tissue is photocross-linked, then the molar abundance of dityrosine bonds is measured using liquid chromatography tandem mass spectrometry and the resulting structural integrity assessed. The cell function and tissue survival of photocross-linked grafts is evaluated ex vivo and in vivo, with tissue integration and vascularization assessed using histology and microcomputed tomography. The photocross-linking strategy is tailorable, allowing progressive increases in the structural fidelity of lipoaspirate, as measured by a stepwise reduction in fiber diameter, increased graft porosity and reduced variation in graft resorption. There is an increase in dityrosine bond formation with increasing photoinitiator concentration, and tissue homeostasis is achieved ex vivo, with vascular cell infiltration and vessel formation in vivo. These data demonstrate the capability and applicability of photocrosslinking strategies for improving structural control in clinically-relevant settings, potentially achieving more desirable patient outcomes using minimal manipulation in surgical procedures.
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Affiliation(s)
- Gretel Major
- Department of Orthopaedic Surgery and Musculoskeletal MedicineCentre for Bioengineering & NanomedicineUniversity of OtagoChristchurch8011New Zealand
| | - Alessia Longoni
- Department of Orthopaedic Surgery and Musculoskeletal MedicineCentre for Bioengineering & NanomedicineUniversity of OtagoChristchurch8011New Zealand
| | - Jeremy Simcock
- Department of SurgeryUniversity of OtagoChristchurch8011New Zealand
| | - Nicholas J Magon
- Centre for Free Radical ResearchDepartment of Pathology and Biomedical ScienceUniversity of OtagoChristchurch8011New Zealand
| | - Jessica Harte
- Jacqui Wood Cancer CentreDivision of Cellular MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeScotlandDD2 1GZUK
| | - Boushra Bathish
- Department of Orthopaedic Surgery and Musculoskeletal MedicineCentre for Bioengineering & NanomedicineUniversity of OtagoChristchurch8011New Zealand
- Jacqui Wood Cancer CentreDivision of Cellular MedicineNinewells Hospital and Medical SchoolUniversity of DundeeDundeeScotlandDD2 1GZUK
| | - Roslyn Kemp
- Department of Microbiology and ImmunologyUniversity of OtagoDunedin9016New Zealand
| | - Tim Woodfield
- Department of Orthopaedic Surgery and Musculoskeletal MedicineCentre for Bioengineering & NanomedicineUniversity of OtagoChristchurch8011New Zealand
| | - Khoon S Lim
- Department of Orthopaedic Surgery and Musculoskeletal MedicineCentre for Bioengineering & NanomedicineUniversity of OtagoChristchurch8011New Zealand
- Light‐Activated Biomaterials GroupSchool of Medical SciencesUniversity of SydneySydney2006Australia
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de Villeneuve Bargemon JB, Rouveyrol M, Massin V, Jaloux C, Levadoux M. Targeted Partial Arthroscopic Trapeziectomy and Temporary K-Wire Distraction for Basal Joint Arthritis in Young Patients: A Retrospective Study of 39 Thumbs. J Wrist Surg 2023; 12:9-17. [PMID: 36644730 PMCID: PMC9836781 DOI: 10.1055/s-0041-1742204] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/09/2021] [Indexed: 01/26/2023]
Abstract
Purpose There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results We found a significant improvement in pain ( p = 0.005) and grip strength ( p = 0.0021) as well as an improvement in pinch strength ( p = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p = 0.002) and 3 ( p = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence This is a Level IV study.
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Affiliation(s)
| | - Mathias Rouveyrol
- Department of Hand Surgery and Limb Reconstructive Surgery, Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - Valentin Massin
- Department of Orthopedic Surgery, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Charlotte Jaloux
- Department of Hand Surgery and Limb Reconstructive Surgery, Timone Adultes Hospital, Aix Marseille University, Marseille, France
| | - M. Levadoux
- Department of Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
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Winter R, Hasiba-Pappas SK, Tuca AC, Zrim R, Nischwitz S, Popp D, Lumenta DB, Girsch W, Kamolz LP. Autologous Fat and Platelet-Rich Plasma Injections in Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 151:119-131. [PMID: 36219860 DOI: 10.1097/prs.0000000000009789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND For the treatment of carpometacarpal arthritis of the thumb, various therapies are used. Infiltration therapy with autologous substances such as platelet-rich plasma and autologous fat have recently gained increasing attention because of beneficial pain-reducing effects in arthritis and the associated regenerative potential. However, the extent of clinical evidence in this area and how well autologous substances work in terms of pain reduction and improvements in hand function remain unclear. METHODS A systematic review and meta-analysis were conducted to evaluate the current evidence and to provide more insight into pain reduction and improvement in hand function after infiltration of autologous substances. The authors identified 11 clinical trials, of which we included eight in the meta-analysis. RESULTS Autologous substances achieved a good and long-lasting pain reduction, which may also be accompanied by corresponding improvement in hand function. Autologous substances appear to be more effective than corticoid infiltrations. The infiltration of autologous fat seems to be particularly promising in more advanced stages of carpometacarpal arthritis of the thumb. Our meta-analysis showed a mean pain reduction of 2.4 to 3 in visual analogue scale score and a reduction of 18 to 19 points in the Disabilities of the Arm, Shoulder, and Hand questionnaire after infiltration with autologous substances. CONCLUSION Both platelet-rich plasma and autologous fat infiltration offer an efficient and long-lasting, minimally invasive therapy option in the treatment of carpometacarpal arthritis of the thumb.
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Affiliation(s)
- Raimund Winter
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Sophie K Hasiba-Pappas
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Alexandru-Cristian Tuca
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Robert Zrim
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Sebastian Nischwitz
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Daniel Popp
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - David Benjamin Lumenta
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
- Research Unit for Digital Surgery, Medical University of Graz
| | - Werner Girsch
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
| | - Lars-P Kamolz
- From the Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction
- COREMED, the Cooperative Centre for Regenerative Medicine, Joanneum Research GmbH
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First Carpometacarpal Joint Denervation: A Systematic Review. J Hand Surg Am 2022; 47:793.e1-793.e8. [PMID: 34509313 DOI: 10.1016/j.jhsa.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 05/11/2021] [Accepted: 07/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis in the hand. The denervation of the first CMC joint has gained traction as a viable treatment for CMC arthritis. This study reviewed literature on CMC denervation for first CMC arthritis. METHODS A systematic review of papers and abstracts was conducted. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Articles including the results of CMC denervation were included. We compiled data on patient demographics, preoperative testing, intraoperative technique, and postoperative outcomes. Anatomic literature was also reviewed to assess agreement on the innervation of the first CMC joint. RESULTS Six anatomic studies and 9 clinical studies were included in this systematic review. Pinch strength, grip strength, and Kapandji scores increased on average in patients. Pain relief was noted on average in patients in 5 studies that reported pain outcomes. In studies that reported postoperative complications, the most frequent complications were radial paresthesias, hypoesthesia dorsal and/or distal to the surgical site, and wound infection. CONCLUSIONS The innervation of the CMC joint is controversial. This is reflected in clinical practice, wherein varied surgical approaches are used. Carpometacarpal denervation shows promise as an option to treat patients with CMC arthritis without joint instability, but its results vary. Additional clinical studies with longer-term follow-up and control groups are necessary to better determine its longevity and efficacy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Autologous Fat Grafting in the Upper Extremity: Defining New Indications. Plast Reconstr Surg Glob Open 2022; 10:e4469. [PMID: 35999879 PMCID: PMC9390829 DOI: 10.1097/gox.0000000000004469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
Autologous fat grafting is a commonly used technique in plastic surgery that can also be applied broadly in hand surgery. We present a case series to demonstrate the diverse indications for fat grafting in hand surgery. Methods We retrospectively reviewed cases of fat grafting in the upper extremity in 2020. Cases representing a unique application of fat grafting were identified. Patient data, including demographics, diagnoses, preoperative and postoperative assessments, complications, patient satisfaction, and surgical operative reports, were recorded. Results Five patients representing distinct indications for autologous fat grafting in the upper extremity were identified. Indications included hand rejuvenation (20.0%), burn/scar management (20.0%), tenolysis (20.0%), revision nerve decompression (20.0%), and carpometacarpal joint arthritis (20.0%). Average patient age was 60.4 years (range, 42-71). Average volume of fat injected was 15.2 ml (range, 1-37 ml). No major complications were noted (0.0%). All patients expressed satisfaction with their overall result with good functional outcomes (100%). Conclusions Autologous fat grafting can be applied broadly in hand surgery. Indications for fat grafting in hand surgery include hand rejuvenation, burn/scar management, tenolysis, revision nerve decompression, and thumb carpometacarpal arthritis. Hand surgeons can easily incorporate fat grafting into their daily practice. Current literature supports fat grafting as a viable technique in hand surgery with lower-level studies.
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Effects of Intra-Articular Autologous Adipose Micrograft for the Treatment of Osteoarthritis in Dogs: A Prospective, Randomized, Controlled Study. Animals (Basel) 2022; 12:ani12141844. [PMID: 35883392 PMCID: PMC9311928 DOI: 10.3390/ani12141844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/14/2022] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to estimate the safety, feasibility, and efficacy of the intra-articular treatment of autologous microfragmented adipose tissue in dogs with spontaneous osteoarthritis (OA) in comparison with hyaluronic acid (HA), the standard intra-articular treatment. Specifically, it clinically evaluated pain and lameness, the radiographic progression of osteoarthritis, and synovial fluid inflammation. This was a prospective, single-center, parallel-group, randomized, controlled, in vivo clinical study. Participants (n = 40) received either a single intra-articular injection of microfragmented adipose tissue or a single intra-articular injection of HA (1:1). Clinical outcomes were determined using a specialistic clinician assessment obtained by the completion of a specific clinical form based on the Vesseur modified lameness classification system, a pain evaluation using the Visual Analogue Scale (VAS), the measurement of the range of motion (ROM) of the affected joint, limb circumference, and the owners' score evaluation using the Canine Brief Pain Inventory (CBPI) for up to 6 months after the time of injection. Patients underwent a radiographic examination to establish the degree of OA in the affected joint, and synovial fluid samples were collected to assess the biochemical environment of the joint and evaluate and quantify the cellular population and the presence of three specific inflammation biomarkers for up to 60 days. The results of this study suggest that microfragmented autologous adipose tissue is safe and can effectively relieve pain and improve function in dogs with spontaneous articular OA. This one-step procedure is simple, timesaving, cost-effective, minimally invasive, and eliminates the need for complex and time-intensive cell culture processing. Furthermore, the clinical evidence and cytological results suggest better long-term pain control, resulting in an improvement in joint function, compared to HA treatment. The canine spontaneous OA model could play a key role in developing successful treatments for human medicine.
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Myncke I, Vanhees M, Verstreken F. Our Treatment Strategy for CMC-1 Osteoarthritis. HANDCHIR MIKROCHIR P 2022; 54:244-252. [PMID: 35649427 DOI: 10.1055/a-1808-7096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteoarthritis of the carpometacarpal joint of the thumb ( CMC-1) is a common problem and many patients will seek medical attention and may eventually need surgical treatment. As no treatment option has shown consistent superiority, a variety of surgical procedures have been proposed. In this review paper we present our algorithm for the approach of symptomatic CMC-1 osteoarthritis, supported by scientific evidence and our personal experience. It is primarily based on patient demands, status of CMC-1 disease and associated problems around the thumb. The selection of a successful surgical treatment plan with restoration of a pain free and fully functional thumb is the goal. We'll outline the pro's and con's of the surgical procedures and although trapeziectomy has long been the gold standard, the advent of reliable total joint arthroplasties with good short and long-term outcome reports has changed our treatment protocol completely.
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Lipofilling in Osteoarthritis of the Finger Joints: Initial Prospective Long-Term Results. Plast Reconstr Surg 2022; 149:1139-1145. [PMID: 35271532 DOI: 10.1097/prs.0000000000008989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is considerable interest in the possibility of offering an alternative and less invasive method of treatment for osteoarthritis that will preserve the joint. This article presents for the first time the long-term results of a prospective study following autologous fat transfer to arthritic finger joints. METHODS The authors report on 28 finger joints with osteoarthritis that they treated by injecting fatty tissue into the joints. The degree of pain, force of pinch grip, and fist closure were assessed and hand function was determined using the German version of the Disabilities of the Arm, Shoulder and Hand questionnaire. RESULTS The average follow-up period during the study was 44 months. The median force of pinch grip rose highly significantly from 2.00 kg (range, 0.00 to 11.00 kg) to 4.30 kg (range, 2.00 to 12.00 kg) (p < 0.001). The median force of fist closure rose from 15.00 kg (range, 2.00 to 44.00 kg) to 18.00 kg (range, 3.78 to 42.00 kg) (p = 0.082). The median Disabilities of the Arm, Shoulder and Hand value improved nonsignificantly from 50 (range, 3 to 72) to 25 (range, 0 to 85) (p = 0.129). The median level of pain experienced showed a highly significant improvement from 6.0 (range, 1.0 to 10.0) to 0.5 (range, 0.0 to 6.5) (p < 0.001). CONCLUSIONS Even over a long-term study period, the transfer of fatty tissue to arthritic finger joints has shown itself to be a minimally invasive, safe and promising alternative treatment to conventional surgical procedures that offers significant improvements in terms of osteoarthritis symptoms. Because this method preserves the joint, conventional resection surgery still remains a later option. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Recent Biomimetic Approaches for Articular Cartilage Tissue Engineering and Their Clinical Applications: Narrative Review of the Literature. Adv Orthop 2022; 2022:8670174. [PMID: 35497390 PMCID: PMC9054483 DOI: 10.1155/2022/8670174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
Since articular cartilage is lacking blood vessels and nerves, its capacity to heal is extremely limited. This means that ruptured cartilage affects the joint as a whole. A health issue known as osteoarthritis can develop as a result of injury and deterioration. Osteoarthritis development can be speeded up by the widespread deterioration of articular cartilage, which ranks third on the list of musculoskeletal disorders requiring rehabilitation, behind only low back pain and broken bones. The current treatments for cartilage repair are ineffective and rarely restore full function or tissue normalcy. A promising new technology in tissue engineering may help create functional cartilage tissue substitutes. Ensuring that the cell source is loaded with bioactive molecules that promote cellular differentiation and/or maturation is the general approach. This review summarizes recent advances in cartilage tissue engineering, and recent clinical trials have been conducted to provide a comprehensive overview of the most recent research developments and clinical applications in the framework of degenerated articular cartilage and osteoarthritis.
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Karagergou E, Ligomenou T, Chalidis B, Kitridis D, Papadopoulou S, Givissis P. Evaluation of Adipose Cell-Based Therapies for the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. Biomolecules 2022; 12:biom12030473. [PMID: 35327665 PMCID: PMC8946069 DOI: 10.3390/biom12030473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/04/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022] Open
Abstract
Adipose tissue and its regenerative products which are isolated with enzymatic or mechanical processing of the harvested fat have been studied in a wide range of degenerative diseases, including osteoarthritis of the knee and hip. Intra-articular injection of these products can provide symptomatic relief of pain and postpone surgery. However, their use in the treatment of thumb carpometacarpal joint (CMCJ) osteoarthritis is limited and just a few studies have been published on that topic. For this reason, a review of the literature was performed by a thorough search of eight terms using the Pubmed database. In total, seven human studies met the selection criteria, including case-control studies, case-series and one case report. In all studies, intra-articular injection of autologous fat in osteoarthritic thumb CMCJ provided reduction in pain and improvement in hand function. Grip and pinch strength showed variable results, from no change to significant improvement. Fat-processing techniques were based on centrifugation and mechanical homogenization but biological characterization of the injected cells was not performed in any study. Although the results are encouraging, a uniformly standardized method of fat processing and the conduction of randomized controlled trials in the future could better evaluate the effectiveness of this procedure for thumb CMCJ osteoarthritis.
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Affiliation(s)
- Eleni Karagergou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
- Correspondence: ; Tel.: +30-69-7238-6716
| | - Theodora Ligomenou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Byron Chalidis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
| | - Sophia Papadopoulou
- Department of Burns, Plastic Surgery and Hand Surgery, Georgios Papanikolaou Hospital, 57010 Thessaloniki, Greece; (T.L.); (S.P.)
| | - Panagiotis Givissis
- 1st Orthopaedic Department, School of Medicine, Georgios Papanikolaou Hospital, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece; (B.C.); (D.K.); (P.G.)
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[Minimally invasive procedures in the early stages of trapeziometacarpal joint osteoarthritis : Denervation, arthroscopy and autologous fat transplantation]. DER ORTHOPADE 2022; 51:13-22. [PMID: 35015097 DOI: 10.1007/s00132-021-04198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Resection arthroplasty of the trapezium with or without tendon interposition is the standard procedure in the treatment of advanced, symptomatic thumb carpometacarpal joint osteoarthritis. Treatment recommendation in the early stages without visible or minimal radiographic changes is often difficult, especially when conservative treatment methods have already been exhausted. In these cases, there is the possibility of the minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation. OBJECTIVES Which minimally invasive procedures are available for the treatment of thumb carpometacarpal joint osteoarthritis and how is their value to be assessed? METHODS The minimally invasive methods of denervation, arthroscopic procedures and autologous fat transplantation for the treatment of thumb carpometacarpal joint osteoarthritis are described and current results from the literature are discussed. RESULTS Good results have been reported with all three procedures. However, the reports are almost exclusively based on retrospective studies with small numbers of patients, which lack control groups, so the results cannot be regarded as definitive. CONCLUSIONS Denervation, arthroscopic procedures and autologous fat transplantation appear to be suitable methods in the early stages of thumb carpometacarpal joint osteoarthritis. Further studies, especially comparative randomised trials that report medium and long-term results, would allow further assessment of these methods.
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14
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Larsen CG, Schaffler BC, Neufeld EV, Alba B, Doering TA, Chen YH, Kasabian AK, Nellans KW, Lane LB, Grande DA. The Effects of Autologous Fat Transfer in an In Vitro Model of Basal Joint Osteoarthritis. J Hand Surg Am 2021; 48:406.e1-406.e9. [PMID: 34974955 DOI: 10.1016/j.jhsa.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Basal joint osteoarthritis (OA) is a highly prevalent and debilitating condition. Recent clinical evidence suggests that autologous fat transfer (AFT) may be a promising, minimally invasive treatment for this condition. However, the mechanism of action is not fully understood. It is theorized that AFT reduces inflammation in the joint, functions to regenerate cartilage, or acts as a mechanical buffer. The purpose of this study was to better understand the underlying mechanism of AFT using an in vitro model. We hypothesize that the addition of stromal vascular fraction (SVF) cells will cause a reduction in markers of inflammation. METHODS Articular chondrocytes were expanded in culture. Liposuction samples were collected from human subjects and processed similarly to AFT protocols to isolate SVF rich in adipose-derived stem cells. A control group was treated with standard growth media, and a positive control group (OA group) was treated with inflammatory cytokines. To mimic AFT, experimental groups received inflammatory cytokines and either a low or high dose of SVF. Expression of relevant genes was measured, including interleukin (IL)-1ß, IL-1 receptor antagonist, and matrix metalloproteinases (MMP). RESULTS Compared to the OA group, significant decreases in IL-1ß, MMP3, and MMP13 expression on treatment day 3 were found in the high-dose SVF group, while MMP13 expression was also significantly decreased in the low-dose SVF group on day 3. CONCLUSIONS In this study, we found that SVF treatment reduced expression of IL-1ß, MMP3, and MMP13 in an in vitro model of OA. These results suggest that an anti-inflammatory mechanism may be responsible for the clinical effects seen with AFT in the treatment of basal joint OA. CLINICAL RELEVANCE An anti-inflammatory mechanism may be responsible for the clinical benefits seen with AFT for basal joint arthritis.
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Affiliation(s)
| | | | - Eric V Neufeld
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY
| | - Brandon Alba
- Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | - Travis A Doering
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY
| | - Yen H Chen
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY
| | - Armen K Kasabian
- Department of Plastic and Reconstructive Surgery, Northwell Health, New Hyde Park, NY
| | - Kate W Nellans
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Lewis B Lane
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
| | - Daniel A Grande
- Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Feinstein Institute for Medical Research at Northwell Health, Manhasset, NY
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15
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Falkner F, Tümkaya MA, Thomas B, Bigdeli AK, Kneser U, Harhaus L, Bickert B. [Conservative treatment options for symptomatic thumb trapeziometacarpal joint osteoarthritis]. DER ORTHOPADE 2021; 51:2-8. [PMID: 34910236 DOI: 10.1007/s00132-021-04195-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are numerous non-surgical treatment options for basal thumb osteoarthritis (OA). OBJECTIVES Aetiology, clinical appearance and diagnosis of basal thumb OA, explanation of the individual non-surgical treatment options, presentation of the current state of studies. MATERIAL AND METHODS Search for case analyses, studies, systematic reviews and meta-analyses using PubMed and LIVIVO. RESULTS Intraarticular injections have no more than short-term success with the risk of infection, which should not be underestimated. Radiotherapy seems to be an effective treatment, but little research has been done on this. Physiotherapy and splinting treatment promise long-term improvement of clinical symptoms and hand function. CONCLUSION Basal thumb OA is a common and serious condition, which in the case of continuous pain should be diagnosed and treated adequately. A multi-modal therapeutic regimen with avoidance of repetitive intra-articular injections seems to provide the best long-term results.
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Affiliation(s)
- Florian Falkner
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland. .,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland.
| | - Mahmut Arman Tümkaya
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Benjamin Thomas
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Amir K Bigdeli
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Ulrich Kneser
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Leila Harhaus
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
| | - Berthold Bickert
- Hand‑, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.,Hand‑, Plastische und Rekonstruktive Chirurgie, Universität Heidelberg, Heidelberg, Deutschland
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16
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Meyer-Marcotty MV, Batsilas I, Fischer H, Dahmann S, Happe C, Herold C. [A prospective Study about medium-term Results after autologous Fat Transplantation into arthritic CMC-I-joints]. HANDCHIR MIKROCHIR P 2021; 54:38-43. [PMID: 34706379 DOI: 10.1055/a-1554-4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Prospective study to evaluate the midterm results after transfer of autologous fat into osteoarthritic CMC-I-joints. PATIENTS AND METHODS 23 out of 27 patients (22 females and 5 men) with an average age of 59,8 (49-83) years with osteoarthritis of the CMC I joint were treated with a fat transfer into the damaged joints. The follow-up was 45,3 (39,3-50,9) months. 4 patients were excluded from the follow-up because of a resection arthroplasty in the meantime. Grip strength and pinch strength, DASH questionnaires and pain (VAS) were analysed. RESULTS The average pinch strength increased from preoperatively 3,7 kg to 5,1 kg postoperatively (p = .052). The average grip strength increased minimally from preoperatively 22,2 kg to 22,8 kg at follow-up (p = .506). The average DASH score improved significantly from preoperatively 50,8 to 29,6 postoperatively (p = 0,000). The average pain level decreased significantly from preoperatively 5,9 to 1,9 at follow up (p = .000). Patients with an advanced osteoarthritis of the CMC-I-joint had similar results as patients with a minor osteoarthritis. CONCLUSION The autologous fat transfer into the osteoarthritic CMC-I-joint showed in midterm follow-up good to very good clinical results regarding pinch strength, pain and DASH score. It is a safe minimal invasive promising alternative to accepted surgical therapies in the treatment of osteoarthritis of the CMC-I-joint.
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Affiliation(s)
- Max V Meyer-Marcotty
- Klinikum Lüdenscheid, Klinik für Plastische, Rekontruktive und Ästhetische Chirurgie/Handchirurgie.,Geteilte Erstautorenschaft
| | - Ioannis Batsilas
- Klinikum Lüdenscheid, Klinik für Plastische, Rekontruktive und Ästhetische Chirurgie/Handchirurgie.,Geteilte Erstautorenschaft
| | - Hubert Fischer
- Klinikum Stadt Soest gGmbH, Institut für Diagnostische Radiologie Nuklearmedizin
| | - Sonja Dahmann
- Klinikum Stadt Soest gGmbH, Klinik für Plastische, Hand und Wiederherstellungschirurgie
| | - Caroline Happe
- Klinikum Stadt Soest gGmbH, Klinik für Plastische, Hand und Wiederherstellungschirurgie
| | - Christian Herold
- DIAKO Bremen, Chirurgische Klinik, Sektion Plastische und Ästhetische Chirurgie
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17
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Rothenfluh E, Besmens IS, Frueh FS, Guidi M, Calcagni M. [Pain In the Thumb and Other Fingers]. PRAXIS 2021; 110:653-659. [PMID: 34521268 DOI: 10.1024/1661-8157/a003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pain In the Thumb and Other Fingers Abstract. As the population ages, symptoms of osteoarthritis in the hand are seen with increasing frequency. It can lead to substantial pain, physical disability and impair the patient's capacity to work in a population with an increasing retirement age. This article gives an overview about the most prevalent forms of osteoarthritis in the hand, its diagnosis and current treatment options, stressing that the multimodal form of therapy is the most effective.
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Affiliation(s)
- Esin Rothenfluh
- Abteilung für Plastische Chirurgie und Handchirurgie Universitätsspital Zürich, Zürich
| | - Inga S Besmens
- Abteilung für Plastische Chirurgie und Handchirurgie Universitätsspital Zürich, Zürich
| | - Florian S Frueh
- Abteilung für Plastische Chirurgie und Handchirurgie Universitätsspital Zürich, Zürich
| | - Marco Guidi
- Abteilung für Plastische Chirurgie und Handchirurgie Universitätsspital Zürich, Zürich
| | - Maurizio Calcagni
- Abteilung für Plastische Chirurgie und Handchirurgie Universitätsspital Zürich, Zürich
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18
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Deptula P, Fox P. Autologous Fat Grafting in Hand Surgery. J Hand Surg Am 2021; 46:594-600. [PMID: 33858716 DOI: 10.1016/j.jhsa.2021.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/02/2023]
Abstract
Autologous fat grafting is commonly used in plastic and reconstructive surgery, but its indications are less well known in the hand surgery literature. Autologous fat grafting is frequently used for its anti-inflammatory, proangiogenic, and regenerative properties, which can be useful in treating the hand and upper extremity. We present a summary of the current literature on autologous fat grafting in the hand and upper extremity and discuss the applications, outcomes, techniques, safety, and level of evidence.
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Affiliation(s)
- Peter Deptula
- Division of Plastic and Reconstructive Surgery, Stanford Medical Center, Stanford, CA
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Stanford Medical Center, Stanford, CA.
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19
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Tenti S, Cheleschi S, Mondanelli N, Giannotti S, Fioravanti A. New Trends in Injection-Based Therapy for Thumb-Base Osteoarthritis: Where Are We and where Are We Going? Front Pharmacol 2021; 12:637904. [PMID: 33927620 PMCID: PMC8079141 DOI: 10.3389/fphar.2021.637904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
Thumb-base osteoarthritis (TBOA) is a common condition, mostly affecting post-menopausal women, often inducing a significant impact on quality of life and hand functionality. Despite its high prevalence and disability, the therapeutic options in TBOA are still limited and few have been investigated. Among the pharmacological strategies for TBOA management, it would be worthwhile to mention the injection-based therapy. Unfortunately, its efficacy is still the subject of debate. Indeed, the 2018 update of the European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) stated that intra-articular (IA) injections of glucocorticoids should not generally be used, but may be considered in patients with painful interphalangeal joints, without any specific mention to the TBOA localization and to other widely used injections agents, such as hyaluronic acid (HA) and platelet-rich plasma (PRP). Even American College of Rheumatology (ACR) experts conditionally recommended against IA HA injections in patients with TBOA, while they conditionally encouraged IA glucocorticoids. However, the recommendations from international scientific societies don’t often reflect the clinical practice of physicians who routinely take care of TBOA patients; indeed, corticosteroid injections are a mainstay of therapy in OA, especially for patients with pain refractory to oral treatments and HA is considered as a safe and effective treatment. The discrepancy with the literature data is due to the great heterogeneity of the clinical trials published in this field: indeed, the studies differ for methodology and protocol design, outcome measures, treatment (different formulations of HA, steroids, PRP, and schedules) and times of follow-up. For these reasons, the current review will provide deep insight into the injection-based therapy for TBOA, with particular attention to the different employed agents, the variety of the schedule treatments, the most common injection techniques, and the obtained results in terms of efficacy and safety. In depth, we will discuss the available literature on corticosteroids and HA injections for TBOA and the emerging role of PRP and other injection agents for this condition. We will consider in our analysis not only randomized controlled trials (RCTs) but also recent pilot or retrospective studies trying to step forward to identify satisfactory management strategies for TBOA.
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Affiliation(s)
- Sara Tenti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sara Cheleschi
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neuroscience, Orthopedics and Traumatology Unit, University of Siena, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neuroscience, Orthopedics and Traumatology Unit, University of Siena, Siena, Italy
| | - Antonella Fioravanti
- Department of Medicine, Surgery and Neuroscience, Rheumatology Unit, Clinic for the Diagnosis and Management of Hand Osteoarthritis, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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20
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Flexor tendon repair outcomes with fat grafting. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-020-01716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Messina JC, Torretta F, Randelli PS. Autologous chondrocyte transplantation in the treatment of thumb CMC joint osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40S:S21-S28. [PMID: 33486105 DOI: 10.1016/j.hansur.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
Degenerative thumb carpometacarpal (CMC) joint osteoarthritis is a common disease in women starting at 40-50 years of age. Nevertheless, synovitis and initial cartilage damage start earlier, and then degenerative arthritis develops leading to joint narrowing with progressive exposure of subchondral bone, subluxation, osteophyte formation and joint deformity that can impact the surrounding joints. The aim of this study was to evaluate the outcome of patients treated with autologous chondrocyte transplantation at the thumb CMC joint at early stages. A prospective study on 10 cases of thumb CMC osteoarthritis in 8 patients was done. The thumbs were stage Eaton II (2 cases) and III (8 cases) and were treated by CMC arthroplasty with the implant of autologous chondrocytes by an open or arthroscopic technique. Two patients were treated bilaterally. Preoperatively all patients had persistent pain resistant to various kinds of nonoperative treatments for at least 1 year. Mean preoperative pinch strength was 3.7 Kg pain on VAS was 8, DASH was 55. All patients had limited abduction and flexion at the end range. Ethics committee approval was obtained for this study. Fragments of 3-4 mm of cartilage were harvested by arthroscopy or by an open technique from the wrist or elbow joint. Cartilage cells were sent to the laboratory to be grown on a collagenous biphasic matrix (MACI/Novocart®). After 3 weeks, the chondrocyte augmented scaffold was ready to be implanted in the thumb CMC joint, or frozen for a second operation later. All patients were females aged 42-67 years (mean 52 years). The dominant hand was treated in 6 cases. In 7 cases, the patients were operated with an open technique and in three cases by arthroscopy. Partial trapezium resection and dorsoradial ligament reconstruction was added to stabilize the CMC joint in most cases. Patients were seen in person at 1, 3, and 6, months, 1 year, 2 years, and 5 years after the initial surgery. Patients (nine thumbs) were then reviewed at a mean follow up 8 years (range 4.4-11 years); pain on VAS, Mayo, DASH and PRWE scores were evaluated at follow-up. One patient was lost to follow-up after 2 years. Of those nine hands, seven had an excellent result according to Mayo score, one had a good result. One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. All patients regained full range of motion. Mean pinch strength increased to 6.25 ± 1.3 Kg, mean DASH score was 7.3 ± 6.7; pain on VAS was 1.0 ± 1.5; these data were statistically significant compared to preoperative values (p < 0.01). Grip strength also increased in all cases, but this was not statistically significant. PRWE was 7.7 ± 6.4. No complications occurred postoperatively. The results obtained are encouraging since the implanted cartilage has lasted a mean of 8 years and up to 11 years. Biological tissue engineering techniques are being developed and could be a new solution to restore normal cartilage in young patients to postpone more aggressive surgical procedures until an older age. In cases of CMC joint instability, a ligament stabilization procedure was added to avoid subsequent damage to the implanted neocartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure, which has the advantage of being completely biological but the disadvantage of being costly.
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Affiliation(s)
- J C Messina
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy.
| | - F Torretta
- Former Head of Hand Surgery Unit - Gaetano Pini Ortohopaedic Institute Milano, MI Italy
| | - P S Randelli
- First Orthopedic Clinic, University of Milan, Gaetano Pini Orthopedic Institute- CTO Orthopedic and Traumatology Centre, Via Gaetano Pini, 9, 20122 Milano MI, Italy; Laboratory of Applied Biomechanics, Department of Biomedical Sciences, University of Milan, Via Gaetano Pini, 9, 20122 Milano MI, Italy
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22
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Copeland A, Gallo L, Weber C, Moltaji S, Gallo M, Murphy J, Axelrod D, Thoma A. Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review. J Hand Surg Am 2021; 46:65.e1-65.e11. [PMID: 32819777 DOI: 10.1016/j.jhsa.2020.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE In the thumb carpometacarpal (CMC) joint osteoarthritis (OA) literature, there is substantial heterogeneity in outcome and outcome measure reporting. This could be rectified by a standardized core outcome set (COS). This study aimed to identify a comprehensive list of outcomes and outcome measures for thumb CMC joint OA, which represents the first step in developing a COS. METHODS A computerized search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed to identify randomized controlled trials, as well as observational studies involving at least 50 participants aged greater than 18 years undergoing surgery for thumb CMC joint OA. Reported outcomes and outcome measures were extracted from these trials and summarized. RESULTS This search yielded 3,498 unique articles, 97 of which were used for analysis. A total of 33 unique outcomes and 25 unique outcome measures were identified. The most frequently used outcomes were complications (78), postoperative pain (73), radiologic outcomes (64), and grip strength (63). Within each reported outcome, there was substantial variation in how the outcome was measured. Of the 25 unique outcome measures, 10 were validated. Of the remaining 15, 12 were created ad hoc by the author. The Disabilities of the Arm, Shoulder, and Hand questionnaire was the most commonly reported outcome measure (34%). CONCLUSIONS There is a lack of consensus on critical outcomes after surgery for thumb CMC joint OA. A standardized COS created by stakeholder consensus would improve the consistency and therefore the quality of future research. CLINICAL RELEVANCE This systematic review of outcomes represents the first step in developing a core outcome set for thumb CMC joint OA.
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Affiliation(s)
- Andrea Copeland
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christina Weber
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Axelrod
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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23
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Froschauer SM, Holzbauer M, Wenny R, Schmidt M, Huemer GM, Kwasny O, Duscher D. Autologous Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis (Liparthroplasty): A Case Series with Two Years of Follow-UP. J Clin Med 2020; 10:jcm10010113. [PMID: 33396314 PMCID: PMC7795524 DOI: 10.3390/jcm10010113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 01/22/2023] Open
Abstract
Adipose-derived mesenchymal stem cell (ASC) therapy is currently a focus of regenerative medicine. Lipoaspirate is rich in ASCs and is evolving into a promising, less-invasive tool to treat thumb carpometacarpal osteoarthritis as compared with common surgical techniques, for example, trapeziectomy or prosthesis implantation. The present study aimed to examine the effect of 1 mL intraarticular lipoaspirate injection (liparthroplasty) in 31 thumb carpometacarpal osteoarthritis patients (27 woman and four men) with a median age of 58 (interquartile range (IQR) of 10) years and Eaton–Littler Stage 2 or 3. Median pain levels assessed via visual analogue scale significantly decreased from 7 (IQR 2) to 4 (IQR 6) after six months (p < 0.0001) and 2 (IQR 5) after two years (p < 0.0001). Median pre-interventional Disabilities of the Arm, Shoulder and Hand (DASH) scores of 59 (IQR 26) significantly reduced to a value of 40 (IQR 43) after six months (p = 0.004) and to 35 (IQR 34) after two years (p < 0.0001). Subjective grip strength showed no significant improvement. However, the time until recurrence of symptoms was measured and a cumulative remission rate of 58% was detected after two years. Satisfaction rates were 68% after six months and 51% after two years. In conclusion, liparthroplasty represents a promising option to reduce pain and functional impairment and to postpone surgery for a certain period of time.
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Affiliation(s)
- Stefan M. Froschauer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
- Correspondence: ; Tel.: +43-732-780673992
| | - Matthias Holzbauer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
| | - Raphael Wenny
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Manfred Schmidt
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Georg M. Huemer
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
| | - Oskar Kwasny
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (M.H.); (O.K.)
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria;
| | - Dominik Duscher
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 3, 4020 Linz, Austria; (R.W.); (G.M.H.); (D.D.)
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076 Tuebingen, Germany
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24
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Smith OJ, Leigh R, Kanapathy M, Macneal P, Jell G, Hachach-Haram N, Mann H, Mosahebi A. Fat grafting and platelet-rich plasma for the treatment of diabetic foot ulcers: A feasibility-randomised controlled trial. Int Wound J 2020; 17:1578-1594. [PMID: 32633854 DOI: 10.1111/iwj.13433] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic, nonhealing diabetic foot ulcers (DFU) are increasing in prevalence and are often unresponsive to conventional therapy. Adipose tissue, containing adipose-derived stem cells, and platelet rich plasma (PRP) are regenerative therapies rich in growth factors which may provide a solution to chronic wound healing. This study aimed to assess the feasibility of conducting a definitive randomised controlled trial (RCT) to investigate the efficacy of these therapies for the treatment of DFU. This was a single centre, feasibility, three-arm, parallel group RCT. Eligible DFU patients were randomised on a 1:1:1 basis to three intervention arms: control (podiatry); fat grafting; fat grafting with PRP. The intervention was delivered once and patients were followed-up for 12 weeks. The primary objective was to assess measures of trial feasibility. Clinical outcomes and health-related quality of life (HRQoL) were also evaluated. Three hundred and thirty four patients were screened and 32 patients (9.6%) were deemed eligible with 18 enrolled in the trial (6 per arm) over 17 months. All participants completed the trial with no withdrawals or crossover. Participant engagement was high with most HRQoL questionnaires returned and only 4.8% follow-up appointments missed. There were five adverse events (AEs) related to the trial with no serious AEs. Five (28%) of the wounds healed. There was no difference between any of the groups in terms of clinical outcomes. This feasibility study demonstrated that a multi-centre RCT is safe and feasible with excellent patient engagement. We have highlighted crucial information regarding methodology and recruitment, which will guide future trial design. Registration number: NCT03085550 clinicaltrials.gov. Registered 01/03/2017.
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Affiliation(s)
- Oliver J Smith
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Richard Leigh
- Department of Podiatry, Royal Free Hospital, London, UK
| | | | - Peter Macneal
- Department of Plastic Surgery, St George's Hospital, London, UK
| | - Gavin Jell
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Haroon Mann
- Department of Trauma and Orthopaedics, Royal Free Hospital, London, UK
| | - Ash Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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25
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Bonetti MA, Rovere G, Fulchignoni C, De Santis V, Ziranu A, Maccauro G, Pataia E. Autologous fat transplantation for the treatment of trapeziometacarpal joint osteoarthritis. Orthop Rev (Pavia) 2020; 12:8666. [PMID: 32913600 PMCID: PMC7459373 DOI: 10.4081/or.2020.8666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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26
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Ruettermann M. Changing surgical treatments of thumb carpometacarpal osteoarthritis. J Hand Surg Eur Vol 2020; 45:533-535. [PMID: 32281453 PMCID: PMC7787559 DOI: 10.1177/1753193420915800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- HPC, Oldenburg, Institute for Hand- and Plastic Surgery, Oldenburg, Germany
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27
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One-Year Outcomes of Intraarticular Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case Review of 99 Joints. Plast Reconstr Surg 2020; 145:151-159. [PMID: 31592943 DOI: 10.1097/prs.0000000000006378] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery. METHODS In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman's analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress. RESULTS From 2 weeks on, there was pain relief, both under stress and at rest. Friedman's analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001]. CONCLUSION The authors' preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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28
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Pavarotti GS, Hivernaud V, Brincin M, Roche R, Barreau P, Festy F, Gauthier O. Evaluation of a Single Intra-Articular Injection of Autologous Adipose Tissue for the Treatment of Osteoarthritis: A Prospective Clinical Study in Dogs. Vet Comp Orthop Traumatol 2020; 33:258-266. [PMID: 32316062 DOI: 10.1055/s-0040-1708524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the safety, feasibility and clinical efficacy of a single intra-articular injection of autologous and purified micro-fragmented adipose tissue for the treatment of osteoarthritis (OA) in dogs. STUDY DESIGN Twenty-one client-owned dogs with radiographically confirmed OA were recruited into this prospective study. Lameness and discomfort were evaluated by physical examination at day 0 and then 14, 30, 60 and 180 days after injection. Kinetic data and temporospatial parameters were obtained using a pressure-sensing walkway. Peak vertical force, vertical impulse and percentages of body weight distribution were determined. Owner perception data regarding their own dog's physical activity were also collected using the Canine Brief Pain Inventory. RESULTS Radiographic scores for OA from days 0 to 180 were similar, except in two dogs. No major side effects were noted after injection. Lameness and Canine Brief Pain Inventory scores were significantly lower at all time points compared with day 0. Post-injection results demonstrated gradual improvement of kinetic data up to day 180 compared with pre-treatment values: vertical impulse (>2.25%), peak vertical force (>5.32%) and percentages of body weight distribution (>3.6%). In dogs with elbow OA, gait analysis values significantly increased at all time points compared with day 0. CONCLUSION Regenerative autologous adipose tissue injection therapy is a promising alternative to traditional analgesics treatment in patients with OA, associated with significant reductions in pain and lameness, delayed disease progression and improved quality of life.
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Affiliation(s)
- Greta S Pavarotti
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Vincent Hivernaud
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Mélanie Brincin
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Régis Roche
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Pierre Barreau
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Franck Festy
- Stemcis Cyroi, 2 rue Maxime Rivière, 97490 Ste Clotilde, Ste Clotilde, France
| | - Olivier Gauthier
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes Atlantic College of Veterinary Medicine, Nantes, France
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29
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Reinisch KB, Zuk G, Raptis DA, Bueter M, Guggenheim M, Stasch T, Palma AF. Autologous lipotransfer for bone defects secondary to osteomyelitis: A report of a novel method and systematic review of the literature. Int Wound J 2019; 16:916-924. [PMID: 30916475 DOI: 10.1111/iwj.13119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Autologous bone grafting is the gold standard in patients with bone defects but is associated with significant pain and donor site morbidity. Autologous lipotransfer (fat grafting or lipofilling) has become very popular in the therapy of chronic wounds. Mesenchymal stem cells from adipose tissue are known for their regenerative, reparative, and immunomodulatory effects. This case study and review evaluates the use of autologous lipotransfer for chronic osteomyelitis in a 26-year-old patient. A 26-year-old female suffering from chronic tibial osteomyelitis was initially treated with surgical debridement and antibiotics followed by lipoharvest and autologous lipofilling. MRI and computed tomography scans were performed at 2 and 6 weeks and 6 months postoperatively. A formal systematic review of clinical trials investigating autologous lipotransfer for osteomyelitis was conducted. The patient remained asymptomatic without recurrence, and the bone defect cavity showed vascularised adipose tissue after 6 weeks, with early signs of osteogenesis. The highest foot and ankle disability index was 100. The systematic review identified 266 studies after duplicates were removed. After screening for eligibility, seven manuscripts were further assessed, with none meeting the inclusion criteria. This is the first study to report the successful use of autologous lipotransfer with early signs of osteogenesis in a patient suffering from chronic osteomyelitis. Autologous lipotransfer is relatively simple, safe, and minimally invasive, making it a potential alternative to current treatments. Further research is required to assess the safety, feasibility, and efficacy of autologous fat grafting and the mechanism of osteogenesis.
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Affiliation(s)
- Katharina B Reinisch
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Grzegorz Zuk
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Dimitri A Raptis
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Merlin Guggenheim
- Department of Hand Surgery and Plastic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Stasch
- Private Practice in Plastic und Hand Surgery, Valentis Clinic, Nairobi, Kenya
| | - Adrian F Palma
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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30
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Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results. Int J Mol Sci 2019; 20:ijms20051111. [PMID: 30841510 PMCID: PMC6429478 DOI: 10.3390/ijms20051111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
Wrist osteoarthritis (OA) is one of the most common conditions encountered by hand surgeons with limited efficacy of non-surgical treatments. The purpose of this study is to describe the Platelet-Rich Plasma (PRP) mixed-microfat biological characteristics of an experimental Advanced Therapy Medicinal Product (ATMP) needed for clinical trial authorization and describe the clinical results obtained from our first three patients 12 months after treatment (NCT03164122). Biological characterization of microfat, PRP and mixture were analysed in vitro according to validated methods. Patients with stage four OA according to the Kellgren Lawrence classification, with failure to conservative treatment and a persistent daily painful condition >40 mm according to the visual analog scale (VAS) were treated. Microfat-PRP ATMP is a product with high platelet purity, conserved viability of stromal vascular fraction cells, chondrogenic differentiation capacity in vitro and high secretion of IL-1Ra anti-inflammatory cytokine. For patients, the only side effect was pain at the adipose tissue harvesting sites. Potential efficacy was observed with a pain decrease of over 50% (per VAS score) and the achievement of minimal clinically important differences for DASH and PRWE functional scores at one year in all three patients. Microfat-PRP ATMP presented a good safety profile after an injection in wrist OA. Efficacy trials are necessary to assess whether this innovative strategy could delay the necessity to perform non-conservative surgery.
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31
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Smith OJ, Jell G, Mosahebi A. The use of fat grafting and platelet-rich plasma for wound healing: A review of the current evidence. Int Wound J 2018; 16:275-285. [PMID: 30460739 DOI: 10.1111/iwj.13029] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/16/2018] [Indexed: 12/17/2022] Open
Abstract
Fat grafting is becoming a common procedure in regenerative medicine because of its high content of growth factors and adipose derived stem cells (ADSCs) and the ease of harvest, safety, and low cost. The high concentration of ADSCs found in fat has the potential to differentiate into a wide range of wound-healing cells including fibroblasts and keratinocytes as well as demonstrating proangiogenic qualities. This suggests that fat could play an important role in wound healing. However retention rates of fat grafts are highly variable due in part to inconsistent vascularisation of the transplanted fat. Furthermore, conditions such as diabetes, which have a high prevalence of chronic wounds, reduce the potency and regenerative potential of ADSCs. Platelet-rich plasma (PRP) is an autologous blood product rich in growth factors, cell adhesion molecules, and cytokines. It has been hypothesised that PRP may have a positive effect on the survival and retention of fat grafts because of improved proliferation and differentiations of ADSCs, reduced inflammation, and improved vascularisation. There is also increasing interest in a possible synergistic effect that PRP may have on the healing potential of fat, although the evidence for this is very limited. In this review, we evaluate the evidence in both in vitro and animal studies on the mechanistic relationship between fat and PRP and how this translates to a benefit in wound healing. We also discuss future directions for both research and clinical practice on how to enhance the regenerative potential of the combination of PRP and fat.
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Affiliation(s)
- Oliver J Smith
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Gavin Jell
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ash Mosahebi
- Department of Plastic Surgery, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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32
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Herold C, Rennekampff HO, Allert S. Autologous Fat Transplantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:596. [PMID: 30236223 DOI: 10.3238/arztebl.2018.0596b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reply: Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study. Plast Reconstr Surg 2018; 141:456e-460e. [PMID: 29485595 DOI: 10.1097/prs.0000000000004150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study. Plast Reconstr Surg 2018; 141:455e-456e. [PMID: 29485594 DOI: 10.1097/prs.0000000000004149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Discussion: Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study. Plast Reconstr Surg 2017; 140:336-337. [PMID: 28746280 DOI: 10.1097/prs.0000000000003567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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